Perge Bianka, Papp Gábor, Bói Bernadett, Markóth Csilla, Bidiga László, Farmasi Nikolett, Balla József, Tarr Tünde
Division of Clinical Immunology, Institute of Internal Medicine, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary.
Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, H-4028 Debrecen, Hungary.
J Clin Med. 2025 Jan 21;14(3):665. doi: 10.3390/jcm14030665.
: Lupus nephritis (LN) is one of the most severe organ manifestations of systemic lupus erythematosus (SLE). Chronic kidney disease (CKD) and its progression into end-stage renal disease (ESRD) are serious complications in LN and the main cause of death in SLE. We aimed to investigate the prognostic factors of the progression of CKD and the development of ESRD in SLE patients. : In our retrospective cohort study, we assessed the clinical and laboratory data of 127 patients who were diagnosed with LN between 1990 and 2022 and received regular follow-up care at our autoimmune centre. We compared class IV (diffuse) LN patients with non-class IV LN patients and assessed the differences in clinical and laboratory data of the patients, subdivided into complete, partial, and non-responders to therapy. : The prevalence of class IV LN is significantly higher in patients with CKD stage 3-5. Age above 42, class IV LN, Coombs positivity, and high chronicity index are prognostic factors for the development of CKD stage 3-5. On the other hand, anti-RNP and anti-SS-B antibody positivity and a high chronicity index are prognostic factors for the development of ESRD. The chronicity index, as well as the SLICC/ACR Damage Index (SDI) score, was significantly higher in non-responders compared to patients with complete remission. : Based on our results, the progression of CKD into stage 3-5 or the development of ESRD should be expected at a chronicity index above 3.5 points. An early diagnosis, as well as aggressive, timely, and adequate treatment, is fundamental to prevent unfavourable outcomes of LN.
狼疮性肾炎（LN）是系统性红斑狼疮（SLE）最严重的器官表现之一。慢性肾脏病（CKD）及其进展为终末期肾病（ESRD）是LN的严重并发症，也是SLE的主要死因。我们旨在研究SLE患者中CKD进展和ESRD发生的预后因素。
在我们的回顾性队列研究中，我们评估了1990年至2022年间被诊断为LN并在我们的自身免疫中心接受定期随访的127例患者的临床和实验室数据。我们将IV类（弥漫性）LN患者与非IV类LN患者进行比较，并评估了患者的临床和实验室数据差异，这些患者又细分为治疗完全缓解、部分缓解和无反应者。
CKD 3 - 5期患者中IV类LN的患病率显著更高。42岁以上、IV类LN、库姆斯试验阳性和高慢性指数是CKD 3 - 5期发生的预后因素。另一方面，抗RNP和抗SS - B抗体阳性以及高慢性指数是ESRD发生的预后因素。与完全缓解的患者相比，无反应者的慢性指数以及系统性红斑狼疮国际协作临床/美国风湿病学会损伤指数（SDI）评分显著更高。
根据我们的结果，当慢性指数高于3.5分时，应预期CKD进展至3 - 5期或ESRD发生。早期诊断以及积极、及时和充分的治疗对于预防LN的不良结局至关重要。
